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Inhalant AIT\u00a0is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence\u2010based recommendations for improved patient care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence\u2010based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence\u2010based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Action Statements<\/jats:title><jats:p>The guideline development group made a <jats:italic>strong recommendation<\/jats:italic> that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis.<\/jats:p><jats:p>The guideline development group made <jats:italic>recommendations<\/jats:italic> for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitization, (2)\u00a0reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre\u2010 and co\u2010seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The guideline development group offered the following KASs as <jats:italic>options<\/jats:italic>: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta\u2010blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.650","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T13:50:52Z","timestamp":1708955452000},"page":"635-667","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Executive Summary of Clinical Practice Guideline on Immunotherapy for Inhalant Allergy"],"prefix":"10.1002","volume":"170","author":[{"given":"Richard K.","family":"Gurgel","sequence":"first","affiliation":[{"name":"University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuad M.","family":"Baroody","sequence":"additional","affiliation":[{"name":"The University of Chicago Medicine Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecelia C.","family":"Damask","sequence":"additional","affiliation":[{"name":"Lake Mary ENT and Allergy Lake Mary Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James \u201cWhit\u201d","family":"Mims","sequence":"additional","affiliation":[{"name":"Wake Forest Baptist Health Winston Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey L.","family":"Ishman","sequence":"additional","affiliation":[{"name":"University of Wisconsin\u2010Madison Madison Wisconsin USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dole P.","family":"Baker","sequence":"additional","affiliation":[{"name":"Anderson ENT &amp; Facial Plastics Anderson South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin J.","family":"Contrera","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fariha S.","family":"Farid","sequence":"additional","affiliation":[{"name":"Polyclinic Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Fornadley","sequence":"additional","affiliation":[{"name":"Associated Otolaryngologists of PA, Inc. 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